Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0729233 (Thoracic)
 6,478 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We report the case of a 76-year-old woman who suffered cardiopulmonary arrest three days after being hospitalized with an acute myocardial infarction. She underwent standard cardiopulmonary resuscitative measures for approximately 25 min before being pronounced dead. Autopsy examination revealed a recent myocardial infarction, as well as an acutely fractured tenth thoracic vertebra. Thoracic vertebral fractures are a previously unrecognized complication of cardiopulmonary resuscitation.
 ...
PMID:Thoracic vertebral fracture as a complication of cardiopulmonary resuscitation. 317 Nov 15

Thoracic electromaps were recorded before and after sublingual nitroglycerin (NG) in 26 subjects 15 and 30 days after acute myocardial infarction (MI), in order to evaluate the effect of the drug on injury potentials. Ten patients with documented left ventricular aneurysm were also studied 5 to 46 months after acute MI. Fifteen min after NG there was a significant decrease, compared with basal values, of ST segment elevations, blood pressure and rate-pressure product on both the 15th and 30th days. The degree of ST potentials reduction was not strictly related to the decrease of myocardial oxygen consumption, as indicated by the rate-pressure product. The response to NG on the 15th day did not predict accurately the evolution of injury potentials. In fact there was no significant correlation between percentages reduction of ST after NG on the 15th day and amplitudes of ST segment elevations present on the 30th day. In the patients with ventricular aneurysm, ST potential decrease and hemodynamic changes after NG were similar to those observed in the other groups studied. Our data suggest that it is not possible to differentiate between ST segment elevations associated with a dyssynergic area and those merely due to ischemic injury on the basis of NG sensitivity, and that ST segment elevations in the acute and subacute phase and long after MI have, at least in part, a similar electrophysiological significance.
 ...
PMID:Effect of nitroglycerin on ST potentials in the post-acute phase of myocardial infarction. 679 90

During the period 1968--78, 35 patients with left ventricular aneurysm after acute myocardial infarction were operated on at the Department of Thoracic and Cardiovascular Surgery, University Central Hospital, Helsinki. Twenty patients underwent resection of the left ventricular aneurysm and had coronary bypass grafting (Group I) and 15 patients had aneurysmectomy without revascularization procedures (Group II). Most of the patients (21) had the operation within one year after acute myocardial infarction. The aneurysm was located in the anterior wall in 31 cases and in the posterior wall in 4 cases. Three patients in Group II had a concomitant ventricular septal rupture, which was repaired simultaneously with the aneurysmal resection. In average, the patients in Group I had bypass grafting in 1.8 coronary branches. There were no intra-operative deaths. Three patients in the revascularization group died and 2 patients in the non-revascularization group died during hospitalization (15% hospital mortality). Two patients in the revascularization group and one in the non-revascularization group died during the average follow-up time of 3.4 and 6.4 years for the respective groups (late mortality 10 and 7%). The rest of the patients were doing well, including those with repaired VSDs. Follow-up coronary angiography was carried out of 12 patients; in 10 all the grafts were patent and in 2 one revascularized coronary branch had a patent graft. Revascularization produced apparent relief of anginal symptoms. Its beneficial effects on longevity remained unestablished.
 ...
PMID:Ischaemic cardiac aneurysms and ventricular septal defects. Surgical treatment with and without revascularization. 697 90

Coronary heart disease (CHD) is the leading cause of mortality in the United States. The present cohort study was conducted to determine whether rate of FEV1 loss independently predicts CHD mortality in apparently healthy men. White male Baltimore Longitudinal Study of Aging (BLSA) participants without CHD underwent clinical evaluation at 2-yr intervals; 883 had satisfactory pulmonary and lipid studies and returned for a least one visit. Cases were BLSA subjects without CHD on entry who died a "coronary death" (death from acute myocardial infarction, sudden death, or congestive heart failure in the presence of coronary artery disease). Forced expiratory maneuvers followed American Thoracic Society guidelines. Serum cholesterol, blood pressure, cigarette smoking, and body mass index were obtained from the BLSA database. There were 79 CHD deaths and 804 survivors during an average follow-up of 17.4 yr. After adjustment for age, initial FEV1% predicted, smoking status, hypertension, and cholesterol, a time-dependent proportional hazards model showed that cardiac mortality, but not all causes of mortality, generally increased with increasing quintile of FEV1 decline for the entire cohort (relative risk [RR] 2.92-5.13) and separately for the subset of never-smokers. Thus, excess CHD mortality follows a large decline in FEV1, independent of the initial FEV1% predicted, cigarette smoking, and other common CHD risk factors.
 ...
PMID:Rapid decline in FEV1. A new risk factor for coronary heart disease mortality. 784 97

Thoracic surgery has made important progress thanks to parallel advances in anesthetic techniques, which have lowered mortality and complication rates. Pneumonectomy, however, continues to carry a high risk of perioperative death and morbidity, with complications involving the heart and lung being the most common. Pneumonectomy requires careful preoperative assessment to identify patients at high risk of cardiac complications. However, there is no evidence available on the best approach to take in determining risk of impaired lung function after pneumonectomy. Postoperative arrhythmias increase mortality, although evidence does not suggest a need for systematic prophylactic treatment of patients who will undergo lung resection. The incidence of acute myocardial infarction ranges from 1.5% to 5% and diagnosis is difficult because most episodes are silent. The incidence of post-pneumonectomy pulmonary edema is between 4% and 7% and evidence indicates that prevention is the most important therapeutic measure. Patients tend to have greater risk of pneumonia after thoracotomy, but few studies have provided a high level of evidence for the usefulness of antibiotic prophylaxis in chest surgery. The aim of the present study was to review the literature on the most common complications of surgery on the lung in order to support decision making based on the integration of knowledge and clinical judgment acquired with experience. A MEDLINE search was carried out to locate studies published from 1980 through January 2005.
 ...
PMID:[Cardiovascular and respiratory complications after pneumonectomy]. 1628 43

We describe a rare case of acute myocardial infarction secondary to paradoxical embolism complicating acute pulmonary embolism. A 44-year-old woman presented to the emergency department with chest pain. The physical examination was unremarkable except for oxygen saturation of 75%, and the electrocardiogram showed ST-segment elevation in the inferior leads. Urgent coronary angiography showed a distal occlusion of the right coronary artery and multiple thrombi were aspirated. Despite relief of chest pain and electrocardiogram normalization, her oxygen saturation remained low (90%) with high-flow oxygen by mask. The transthoracic echocardiogram showed a mass in the left atrium and dilatation of the right chambers, while the transesophageal echocardiogram showed a thrombus attached to the interatrial septum in the region of the foramen ovale. Color flow imaging was consistent with a patent foramen ovale. Thoracic computed tomography angiography documented thrombi in both branches of the pulmonary trunk. After five days on anticoagulation, the patient underwent surgical foramen ovale closure.
 ...
PMID:Acute coronary syndrome of paradoxical origin. 2436 28

A 47-year-old man was attended at the emergency room for severe chest pain after eating sausage with subsequent vomiting and mild upper gastrointestinal bleeding. In the chest radiography we could not see abnormalities. He referred previous episodes of choking without consulting. The urgent gastroscopy detected tertiary contractile activity (nutcracker esophagus) and a foreign body in the lower third of the esophagus. After removing the food bolus, we observed a 4 cm longitudinal tear compatible with esophageal rupture or Boerhaave's syndrome in the right posterior wall of the lower esophagus, proximal to the gastroesophageal junction. Thoracic-abdominal computed tomography (TC) confirmed a perforation of the lower esophagus, with pneumothorax and cervical and chest emphysema. Surgical treatment was indicated: esophageal suture, myotomy and gastric fundoplication. The patient presented good evolution. Boerhaave's syndrome is a rare syndrome, but with high mortality (35%). Mackler triad is very characteristic: vomiting, retrosternal pain and cervical subcutaneous emphysema; but it occurs rarely. Chest radiography is useful, showing abnormalities in up to 90% of patients. The differential diagnosis includes cardiorespiratory disorders: acute myocardial infarction, spontaneous pneumothorax, pericarditis or pneumonia. The role of endoscopy is small, mainly limited to prosthesis placement in high-risk surgical patients. In our case the chest radiograph was initially normal, probably related to bolus impaction and, in presence of upper gastrointestinal bleeding, gastroscopy was performed which allowed us to early diagnosis and treatment.
 ...
PMID:Boerhaave's syndrome: diagnostic gastroscopy. 2810 60